ANNEX A (Revised, 7 Apr 2020)

(CAPTION)

DECLARATION

I, _______________________, of legal age, Filipino, and resident of _______________

_________________________ hereby declare that I am the same person who:

___ was arrested without a warrant

___ was arrested
___ voluntary surrendered
___ has been under detention

subject of a Warrant of Arrest dated ___________ issued by ___________________.

I am executing this declaration to attest to the truth of my identity as the accused in

Criminal Case No. ____________, entitled People of the Philippines v. _________________,
under pain of being prosecuted for violation of Art.172, in relation to Art. 171 (2) and Art. 178
of the Revised Penal Code, in the event of discovery of any falsehood in my declaration herein
as to my true identity.

Given this ___ day of ______________ in ______________.

______(name and signature)_________ Assisted by: ____(name and signature)____

Accused Counsel

CERTIFICATION

This is to certify that upon proper verification in the exercise of my official function, I
confirm that the person who was arrested / voluntary surrendered / committed to this jail facility
is one and the same person who is applying for bail. As proof of his identity, attached are his
Declaration of identity, pictures, thumbprints, and a copy of his government-issued identification
card or valid identification card, which all show that he is one and the same person.

I certify under my oath of office that all the above statements are true and correct to my
personal knowledge and belief.

Given this ___ day of ______________ in ______________.

______(name and signature)_________

Law Enforcer / Jail Warden